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BACKWATER PREVENTION VICE PROGRAM <br /> • <br /> Our records indicate that a backwater preyp" on device must be installed on your <br /> sewer connection to comply with the new ordinance. Please help us verify that our <br /> information is correct by answering the following questions about your property: <br /> Do you have a basement? Yes No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes 'No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know 11 <br /> Name: ate/S f /l l.F k_ /Q' <br /> Property address: 2.0 7- /'"l dyT (1/ <br /> Phone 1: YZ ti9.6` `f 3 Phone 2: 4/25'-(/0 '81-(3 <br /> Email: acyrk.e. ) Fria; 1e.(GM <br /> eit jaiate} <br />